<layout name="layout" />

<script src="{$uri}Public/Scripts/PSI/Express/apply.js?dt={$dtFlag}"
	type="text/javascript"></script>

<div class="hd">
	<h1 class="page_title">寄件</h1>
</div>

<div class="bd">
	<div class="weui-cells weui-cells_form">
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">收镖人姓名</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" placeholder="请输入收镖人姓名" id="editRecName">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">目的地-省</label>
			</div>
			<div class="weui-cell__bd">
				<select class="weui-select" id="editToProvince">
				</select>
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">目的地-市</label>
			</div>
			<div class="weui-cell__bd">
				<select class="weui-select" id="editToCity">
				</select>
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">目的地-区县</label>
			</div>
			<div class="weui-cell__bd">
				<select class="weui-select" id="editToDistrict">
				</select>
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">收镖人地址</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" placeholder="请输入收镖人地址" id="editRecAddress">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">收镖电话</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" type="tel" placeholder="请输入收镖电话"
					id="editRecTel">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">托镖人姓名</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" placeholder="请输入托镖人姓名" id="editSendName"
					value="{$myInfo['name']}">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">始发地-省</label>
			</div>
			<div class="weui-cell__bd">
				<select class="weui-select" id="editFromProvince">
				</select>
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">始发地-市</label>
			</div>
			<div class="weui-cell__bd">
				<select class="weui-select" id="editFromCity">
				</select>
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">始发地-区县</label>
			</div>
			<div class="weui-cell__bd">
				<select class="weui-select" id="editFromDistrict">
				</select>
			</div>
		</div>

		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">托镖人地址</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" placeholder="请输入托镖人地址"
					id="editSendAddress" value="{$myInfo['address']}">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">托镖电话</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" type="tel" placeholder="请输入托镖电话"
					id="editSendTel" value="{$myInfo['tel']}">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">镖物</label>
			</div>
			<div class="weui-cell_bd">
				<input class="weui-input" placeholder="请输入镖物" id="editCargo">
			</div>
		</div>
		<div class="weui-cell weui-cell_switch">
			<div class="weui-cell__hd">勿压易碎</div>
			<div class="weui-cell__ft">
				<input class="weui-switch" type="checkbox" id="editFragile">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">申明价值</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" type="number" id="editClaimValue">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">代收货款</label>
			</div>
			<div class="weui-cell__bd">
				<input class="weui-input" type="number" id="editCargoMoney">
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__hd">
				<label class="weui-label">备注</label>
			</div>
			<div class="weui-cell__bd">
				<textarea class="weui-textarea" rows="3" id="editMemo"></textarea>
			</div>
		</div>
		<div class="weui-cell">
			<div class="weui-cell__bd">
				<a href="javascript:;" class="weui-btn weui-btn_primary" id="btnOK">寄件</a>
				<a href="{$uri}Home" class="weui-btn weui-btn_default">取消并返回首页</a>
			</div>
		</div>
	</div>
</div>
